Sciatica back pain is a type of pain that begins in the back and often radiates down the leg as it worsens. The last stages of sciatica can be very painful and have a debilitating impact on mobility. Getting expert medical care for sciatica is essential for managing pain, getting relief, and being able to function normally and comfortably.
What Is Sciatica?
Sciatica refers to pain that begins in the lower back and radiates down the leg and even as far as the foot. This is caused by the compression of nerves in the spine that make up the sciatic nerve. These nerves form a bundle in the lower back. Pain from sciatica often begins in the buttocks or hips and then later travels down the leg.
A common cause of classic sciatica is a ruptured, or herniated, disc in the spine. The ruptured part of the disc presses on nerves causing inflammation and pain. The pain is constant, no matter how you move or position yourself.
Thickened bone or bone spurs can also press on the nerves and cause sciatica pain, also known as positional sciatica. This causes pain mostly when standing and walking. You should feel relief when you sit or bend at the waist.
Learn more about sciatica in this video with Dr. Geissele, an EmergeOrtho back and spine specialist.
What Are the 4 Stages of Sciatica?
Sciatica does not necessarily progress the same way in all patients. While there are no firmly defined stages of sciatica, it may get worse over time or get better and then recur. Patients may experience:
- Early or Acute Sciatica. In the earliest stage, sciatica pain may be acute, meaning it comes on suddenly. Many people experience only back pain in the earliest stages of sciatica and do not seek treatment.
- Worsening Pain. Early sciatica left untreated can advance to more severe pain and pain that radiates past the lower back, into the hips or buttocks, down the leg, or as far as into the foot.
- Chronic Pain. For some patients, sciatica pain and discomfort becomes chronic. The pain may fluctuate from better to worse and back.
- Recurring Sciatica. Even after treatment or using conservative pain management and recovering from sciatica, it can recur later.
Symptoms in the Last Stages of Sciatica
Back pain is a typical early sign of sciatica. As it progresses to the last stages, the pain often radiates down the leg and into the foot. This can become severe and interfere with normal functioning. Additional symptoms may include numbness, tingling, or weakness in the leg or foot. In most people, sciatica affects one side of the body only.
How To Manage Advanced Sciatica Pain
Sciatica pain can become severe and even debilitating, interfering with normal mobility and activities. Before opting for surgical treatment, your orthopedist might recommend some conservative pain management strategies to keep you comfortable while waiting for the injury to heal:
- Over-the-counter anti-inflammatory medications, such as Tylenol
- Prescription anti-inflammatories and oral steroids
- Steroid injections
- Physical therapy
Physical therapy is especially useful in helping manage pain with sciatica before resorting to surgery. Targeted exercises help train the body to function better with pinched nerves. Physical therapy can also support healing and relieve pressure on the compressed nerve.
Surgical Treatment Options for Sciatica
Orthopedists generally prefer to begin treatment for sciatica with conservative treatments to allow the body to heal. Patients with advanced sciatica and severe pain that they cannot tolerate or function with are often good candidates for surgical procedures:
- Laminotomy. This procedure involves removing a small amount of the lamina. The lamina is the bony arch over the spinal cord to relieve pressure on a nerve.
- Laminectomy. In a laminectomy, the surgeon moves all of the lamina. This is more extensive than a laminotomy and usually requires more recovery time.
- Discectomy. This is a procedure used to treat a herniated disc by removing the part of the disc causing nerve compression. A microdiscectomy is less invasive, uses a smaller incision, and requires less recovery time.
If surgery is appropriate for you, your surgeon will discuss the procedure best for your situation. They may combine a laminotomy or laminectomy with a discectomy for better results. Recovery from any of these procedures can be a couple of months but most often leads to less pain and improved mobility.
Early intervention for sciatica is best because it allows you to get relief from pain and supports your body’s natural healing. Getting treated before you have advanced, severe sciatica does not mean you have to have surgery. Your orthopedist will discuss the best option with you.
Whether you have early or advanced sciatic pain, do not hesitate to reach out to a back and spine specialist. Although not common, you could experience nerve damage if you wait too long for treatment.
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